Dietary intake and different types of physical activity: full-day energy expenditure, occupational and leisure-time

OBJECTIVE: To describe the relationship between dietary intake and different levels and types of physical activity (PA). DESIGN: Cross-sectional evaluation of the EPIPorto study. Energy expenditure (metabolic energy equivalent tasks) and dietary intake during the past year were assessed using a PA questionnaire and a semi-quantitative food-frequency questionnaire, respectively. SETTING: Representative sample of adults in Porto, Portugal. SUBJECTS: Data were analysed for 2404 Portuguese Caucasian adults, aged between 18 and 92 years. RESULTS: For total PA, males who were active had significantly higher mean intake of energy (10.76 (2570.7) vs. 9.78 (2336.9) MJ/d (kcal/d), P < 0.001) and lower level of protein consumption (16.9 vs. 17.6 % of energy, P < 0.001) compared with sedentary males. In males, the association between total PA and energy intake remained after adjustment for age, education and body mass index. Similar results were observed when occupational activity was analysed. Concerning the energy expended in leisure time, in both genders, after adjustment for the previously described variables, a significant positive association was found between PA and intake of vitamin C (g/d): beta = 0.12, 99 % confidence interval (CI) 0.02, 0.21 for females and beta = 0.13, 99 % CI 0.03, 0.22 for males. Leisure-time activity in females was also positively associated with intakes of fibre, vitamin E, folate, calcium and magnesium, and negatively associated with saturated fat. CONCLUSIONS: Higher levels of PA in leisure time were associated with higher intakes of micronutrients and lower intakes of saturated fat, particularly in females. For total and occupational PA, similar nutrient intake was observed between active and sedentary individuals.     

Age-related variations in flavonoid intake and sources in the Australian population

OBJECTIVE: To estimate flavonoid intake in the Australian population. DESIGN: Flavonoid consumption was estimated from 24-hour recall data and apparent consumption data using US Department of Agriculture flavonoid composition data. SUBJECTS: The National Nutrition Survey 1995 assessed dietary intake (24-hour recall) in a representative sample (n=13,858) of the Australian population aged 2 years and over. RESULTS: Analysis of the 24-hour recall data indicated an average adult intake (>18 years) of 454 mg day(-1) (92% being flavan-3-ols). Apple was the highest quercetin source until age 16-18 years, after which onion became an increasingly important prominent source. Variations in hesperetin consumption reflected orange intake. Apple, apricot and grapes were the major sources of epicatechin and catechin for children, but subsided as wine consumption increased in adulthood. Wine was the main source of malvidin. Naringenin intake remained static as a percentage of total flavonoid intake until age 19-24 years, corresponding to orange intake, and then increased with age from 19-24 years, corresponding to grapefruit intake. Apparent dietary flavonoid consumption was 351 mg person(-1) day(-1), of which 75% were flavan-3-ols. Black tea was the major flavonoid source (predominantly flavan-3-ols) representing 70% of total intake. Hesperetin and naringenin were the next most highly consumed flavonoids, reflecting orange intake. Both 24-hour recall and apparent consumption data indicated that apigenin intake was markedly higher in Australia than reported in either the USA or Denmark, presumably due to differences in consumption data for leaf and stalk vegetables and parsley. CONCLUSIONS: Tea was the major dietary flavonoid source in Australia. Flavonoid consumption profiles and flavonoid sources varied according to age. More consistent methodologies, survey tools validated for specific flavonoid intakes and enhanced local flavonoid content data for foods would facilitate better international comparisons of flavonoid intake.     

A comparison of four dietary assessment methods in materially deprived households in England

OBJECTIVES: Low-income households in the UK concentrate factors associated with poor record-keeping such as lower literacy, numeracy and English language skills. The present study aimed to (1) compare the validity and acceptability of three dietary survey methods against appropriate reference measures and (2) identify a method which was both valid and acceptable in low-income households. DESIGN: Cross-sectional design comparing three 4-day dietary survey methods (multiple-pass 24-hour recall, food checklist and semi-weighed method) against a 4-day weighed inventory and other reference measures within subjects. SETTING: London, UK, 2001. SUBJECTS: Low-income households were selected using a doorstep screening questionnaire in 18 of the 60 most deprived neighbourhoods in London. Results are based on 384 respondents (159 males, 225 females) aged 2-90 years in 240 households. Respondents were mainly White (48%), Black or Black British (31%) or Asian or Asian British (9%). RESULTS: The dietary survey method preferred by interviewers was the 24-hour recall. Most respondents preferred the food checklist. Compared with the weighed inventory, repeat 24-hour recalls and the food checklist yielded higher estimates of energy and nutrient intakes. The semi-weighed method was least liked and yielded the lowest estimates of intake. CONCLUSIONS: Based partly on evidence presented here and partly on evidence to be presented in later publications, four multiple-pass 24-hour recalls were recommended as the most appropriate method for a national study of diet and nutrition in low-income households in the UK.     

Trends in fruit, vegetable and salad intakes in 9-10-year-old schoolchildren living in Liverpool, 2000-2005

OBJECTIVE: To report on the fruit, vegetable and salad intakes of Liverpool schoolchildren aged 9-10 years over a 5-year period (2000-2005). DESIGN: Cross-sectional observational study. SETTING: Between 75 and 100 Liverpool primary schools took part in each survey year. SUBJECTS: Subjects consisted of five separate cohorts of 9-10-year-old children from all areas of the city. MAIN OUTCOME MEASURES: Number and proportion of boys and girls who reported eating fruit, vegetables and salad on the previous day. RESULTS: There was an upward trend in the reported intake of fruit between 2002 and 2005. Girls were more likely than boys to report eating fruit (P < 0.001). The trend in salad intake was positive. Between 2000 and 2005 there were significant increases in the number of boys (chi2 = 17.57, P = 0.001) and girls (chi2 = 80.56, P = 0.001) eating salad. Girls were significantly more likely to eat salad than boys in all years (chi2 = 58.75, P = 0.001). Trends in vegetable intake were similar to those for salad, with both sexes reporting yearly increases over the 5-year period. The increase in the number of boys who reported eating vegetables between 2000 and 2005 was 23.5% (chi2 = 32.9, P = 0.000). In girls there was a 44.8% increase over the same period (chi2 = 110.3, P < 0.000). CONCLUSIONS: The data reveal positive trends in the fruit, vegetable and salad intakes of Liverpool schoolchildren between 2000 and 2005. Further research is needed to elucidate the specific factors that have enabled the changes to take place.     

Milk as a food for growth? The insulin-like growth factors link

OBJECTIVE: The mechanisms underlying the association of insulin-like growth factor-I (IGF-I) and leg length (a marker of prepubertal growth) with cancer risk are uncertain. One hypothesis is that diet in early childhood might provide the link. The aim of the present study was to examine the association between early diet - in particular, the intakes of cows' milk and dairy products - and height, leg length and IGF-I levels at age 7-8 years.SUBJECTS: Children participating in the Avon Longitudinal Study of Parents and Children.DESIGN: Diet was assessed using a 3-day unweighed food record. Anthropometry, IGF-I and insulin-like growth factor-binding protein-3 (IGFBP-3) were measured by standard methods.RESULTS: Data on both diet and height were available for 744 children (404 boys) and on diet and IGF for 538 (295 boys). After adjusting for energy, both cows' milk and dairy product intakes were positively associated with IGF-I (P=0.040 and 0.027, respectively) and IGFBP-3 levels (P=0.082 and 0.067, respectively). These associations persisted on adjustment for potential confounders, but were abolished on controlling for protein intake. In energy-adjusted models there was only weak evidence of associations of milk and dairy product intakes with anthropometry. In boys only, dairy product intake was positively associated with leg length (equivalent to a 0.058 (0.002, 0.114) standard deviation score increase in leg length per 100 g increase in daily intake).CONCLUSIONS: These data provide some evidence that variation in childhood milk and dairy product intakes underlies associations of leg length, IGF-I and cancer risk. The association appears to be due to the protein content of milk.     

Tracking of energy and nutrient intakes from adolescence to young adulthood: the experiences of the Young Hearts Project, Northern Ireland

OBJECTIVE: To assess tracking of energy and nutrient intakes between adolescence and young adulthood. DESIGN: Longitudinal study of a random sample of adolescents (aged 15 years at baseline). The extent of tracking of dietary intakes (assessed by diet history) was investigated using weighted kappa statistics (kappa). SETTING: Northern Ireland population survey. SUBJECTS: Adolescents who participated in the Young Hearts Project, Northern Ireland at age 15 years, and subsequently at young adulthood aged between 20 and 25 years (n=245 males, n=231 females). RESULTS: Despite overall increases in height and weight (both P<0.001), increases in body mass index in males (P<0.001) and body fatness in females (P<0.001), median reported intakes of energy (kJ kg(-1) day(-1)), carbohydrate (g day(-1)) and fat (g day(-1)) decreased (all P<0.001) over time. Expressed as nutrient densities (per MJ), diets at young adulthood were overall richer in thiamin, vitamin B6, total folate (all P<0.001), vitamin C (P<0.01) and vitamin D (P<0.05). Whereas the nutrient density of the males' diets decreased over time for calcium (P<0.05) and vitamin A (P<0.001), iron and riboflavin densities increased in the females' diet (P<0.001). Tracking of energy (MJ day(-1)) and nutrient intakes (expressed per MJ day(-1)) at the individual level was only poor to fair (all kappa<0.25), indicating substantial drift of subjects between the low, medium and high classes of intake with increasing age. CONCLUSIONS: These data suggest that individual dietary patterns exhibited at 15 years of age are unlikely to be predictive of dietary intakes at young adulthood.     

Complementary foods consumed by 6-12-month-old rural infants in South Africa are inadequate in micronutrients

OBJECTIVE: To determine the nutrient composition of complementary foods consumed by 6-12-month-old South African infants. DESIGN: Nutrient intake was determined for infants who were recruited to participate in a randomised controlled trial using a single 24-hour dietary recall. SETTING/SUBJECTS: Infants aged 6-12 months (n=475) residing in The Valley of a Thousand Hills, a rural area in KwaZulu-Natal, South Africa. RESULTS: Energy and protein intakes from complementary foods were adequate. Infants who consumed infant products (commercially available fortified infant cereals/ready-to-eat canned baby foods/formula milk powder) had significantly higher intakes of calcium, iron, zinc, vitamin A, thiamine, riboflavin, niacin, vitamin B6, vitamin B12 and vitamin C than infants who did not consume any infant products. For infants who consumed infant cereals (n=142), these cereals provided 51% of total iron intake. Infant cereals provided more than 25% of total intake for magnesium, thiamine, niacin and vitamin B12. For infants consuming ready-to-eat canned baby foods (n=77), these products contributed less than 15% of total intake for all the micronutrients. The nutrient density of the complementary diet was less than half the desired density for calcium, iron and zinc. Animal products were consumed by 17% of infants, 26% consumed dairy products and 18% consumed vitamin-A-rich fruit and vegetables during the 24-hour recall period. CONCLUSION: The nutrient composition of complementary foods among rural South African infants was inadequate, especially for iron, zinc and calcium. Strategies should be developed to improve the nutritional quality of their diets.     

Comparison of children's diets as reported by the child via the Youth/Adolescent Questionnaire and the parent via the Willett food-frequency questionnaire

OBJECTIVE: A comparison of a parent-completed Willett food-frequency questionnaire (FFQ) and a self-completed Youth/Adolescent Questionnaire (YAQ) has not yet been conducted. SETTING: In the Diabetes Autoimmunity Study in the Young (DAISY), parents report their child's diet on the FFQ annually from birth until age 10 years, when the child begins to report their own diet using the YAQ. SUBJECTS: To determine the comparability of these collection methods, 89 children aged 10-17 years and their parents completed the YAQ and FFQ, respectively, for the child's previous year's diet. DESIGN: We compared reported intakes for energy, the macronutrients and a variety of micronutrients of interest to the DAISY study. RESULTS: Bland-Altman plots of energy-adjusted differences between questionnaire responses against their means suggested that the two collection methods gave similar results. The average Spearman correlation coefficient of all energy-adjusted nutrient intakes was 0.50, and did not differ significantly by gender (males, r=0.48; females, r=0.46) or age (10-11 years, r=0.49; 12-17 years, r=0.51). While correlated, the nutrient values from the FFQ were higher than the nutrient values from the YAQ. CONCLUSIONS: While reported nutrient intakes are correlated, an indicator variable defining which survey method a nutrient was collected with should be included in any longitudinal data analyses examining nutrient intakes collected with the YAQ and the FFQ as independent predictors of a disease outcome.     

Ethnic differences in 1-year follow-up effect of the Dutch Schoolgruiten Project - promoting fruit and vegetable consumption among primary-school children

OBJECTIVE: To evaluate the effect of a primary school-based intervention providing free fruit and vegetables (F&V), separately for children of Dutch and of non-Western ethnicity. SETTING: Primary schools in two regions (west and east) in The Netherlands. DESIGN AND METHODS: Participating schoolchildren and their parents completed questionnaires at baseline and 1 year later, including questions on usual F&V intake, potential determinants and general demographics. Primary outcomes were the usual fruit intake and the usual vegetable intake as assessed by parent- and child self-reported food frequency measures. Secondary outcome measures were child- or parent-reported taste preference, knowledge of daily recommendations, availability, and accessibility for fruit intake. Multilevel regression analyses were used to assess differences at follow-up adjusted for baseline values between the control and intervention group using both child and parent reports. SUBJECTS: Five hundred and sixty-five children of Dutch ethnicity and 388 children of non-Western ethnicity (mean age 9.9 years at baseline) and their parents. RESULTS: Children of non-Western ethnicity in the intervention group reported a significantly higher vegetable intake (difference = 20.7 g day-1, 95% confidence interval (CI) = 7.6-33.7). A significant positive intervention effect was also found for fruit intake for children of Dutch ethnicity (difference = 0.23 pieces day-1, 95% CI = 0.07-0.39). No significant effects in intake were observed based on parent reports. Significant positive intervention effects were also found for perceived accessibility among children of non-Western ethnicity, as well as for parent-reported taste preference of their child among children of non-Western ethnicity and boys of Dutch ethnicity.CONCLUSION: Providing children with free F&V had some positive effects on child-reported intakes and important correlates of intakes.     

Parental eating behaviours, home food environment and adolescent intakes of fruits, vegetables and dairy foods: longitudinal findings from Project EAT

OBJECTIVE: To examine longitudinal associations of parental report of household food availability and parent intakes of fruits, vegetables and dairy foods with adolescent intakes of the same foods. This study expands upon the limited research of longitudinal studies examining the role of parents and household food availability in adolescent dietary intakes. DESIGN: Longitudinal study. Project EAT-II followed an ethnically and socio-economically diverse sample of adolescents from 1999 (time 1) to 2004 (time 2). In addition to the Project EAT survey, adolescents completed the Youth Adolescent Food-Frequency Questionnaire in both time periods, and parents of adolescents completed a telephone survey at time 1. General linear modelling was used to examine the relationship between parent intake and home availability and adolescent intake, adjusting for time 1 adolescent intakes. Associations were examined separately for the high school and young adult cohorts and separately for males and females in combined cohorts. SUBJECTS/SETTING: The sample included 509 pairs of parents/guardians and adolescents. RESULTS: Vegetables served at dinner significantly predicted adolescent intakes of vegetables for males (P = 0.037), females (P = 0.009), high school (P = 0.033) and young adults (P = 0.05) at 5-year follow-up. Among young adults, serving milk at dinner predicted dairy intake (P = 0.002). Time 1 parental intakes significantly predicted intakes of young adults for fruit (P = 0.044), vegetables (P = 0.041) and dairy foods (P = 0.008). Parental intake predicted intake of dairy for females (P = 0.02). CONCLUSIONS: The findings suggest the importance of providing parents of adolescents with knowledge and skills to enhance the home food environment and improve their own eating behaviours.     

The iodine content of Norwegian foods and diets

OBJECTIVES: To examine dietary iodine sources and to estimate the dietary iodine intake of the Norwegian population. DESIGN: Food iodine analyses carried out in Norway during the last 10 years were compiled, and iodine intake calculated on the basis of food intake data from nation-wide dietary surveys among children and adults. The food intake of adults was measured by a self-administrated food-frequency questionnaire, which covered habitual diet during the past year. The food intake of children was measured by dietary record during four consecutive days. SETTING: Neither household nor industrial iodisation of salt is mandatory in Norway, but some brands of table salt have 5 microg of iodine added per gram of NaCl. In spite of this, the population has been considered iodine-replete for decades, i.e. having an iodine intake well above the Recommended Dietary Allowance of 150 microg day(-1). This assumption has not been substantiated by dietary surveys. SUBJECTS: The adults included 1374 females and 1298 males aged 16-79 years. The children included 185 girls and 206 boys aged 4 years, 411 girls and 404 boys aged 9 years, and 517 girls and 492 boys aged 13 years. RESULTS: The calculated iodine intake was in the range of 100-250 microg day(-1) in the majority of the adult population. The mean iodine intake was 136 microg day(-1) (170 microg I/10 MJ) among women and 176 microg day(-1) (161 microg I/10 MJ) among men. For children the iodine intake was in the range of 100-120 microg day(-1). Milk and dairy products contributed approximately 55% and 70% of the dietary iodine intake in adults and children, respectively. Fish contributed more than 20% of the iodine intake in adults and about 10% in children. The iodine contribution of drinking water was negligible. CONCLUSIONS: While fish has the highest natural concentration of iodine and as such is an excellent iodine source, milk and diary products are the main determinants of iodine intake in the Norwegian population. Iodisation of cow fodder has been mandatory in Norway since 1950 and provides an efficient alternative to universal salt iodisation. Our results show that the dietary iodine intake of adults is in the range considered to be sufficient. The dietary intake of iodine was at recommended levels among the youngest children; however, it decreased among adolescents, especially among girls.     

The role of breakfast in nutrient intake of urban schoolchildren

OBJECTIVES: To ascertain the breakfast habits of 10-15-year-old schoolchildren and to assess the quality of this meal as well as its relationship to the food consumption pattern for the full day. DESIGN: Cross-sectional survey. SUBJECTS AND SETTING: Eight hundred and two schoolchildren, boys and girls, aged 10-15 years, belonging to different urban schools located in Secunderabad, Andhra Pradesh, India. METHOD: The breakfast eating patterns of the children were studied and their impact on growth was assessed, using dietary recalls and anthropometric measurements. RESULTS: Only 42.8% of the children ate breakfast regularly. Over half of the children skipped breakfast, ranging from daily to once in two weeks. The energy and protein composition of breakfasts eaten by the children indicated that those who did not skip breakfast met one-quarter to one-third of their total daily energy and protein requirements. Mean nutrient intakes calculated from 24-hour recalls revealed that the children's diets were inadequate compared with the recommended values for energy and protein. The inadequate energy intake was reflected in a high incidence of malnutrition in both boys and girls; 40.3% of the boys and 32.1% of the girls studied were found to be underweight. Protein intake was also inadequate among boys and girls, although a higher percentage of children met their protein requirements. CONCLUSIONS: Over half of the schoolchildren studied skipped breakfast frequently, the main reason being getting up late. Children who consumed breakfast had higher daily intakes of energy and protein than children who skipped breakfast. These data confirm the importance of breakfast to overall dietary quality and adequacy in school-aged children.     

Prevalence of Helicobacter pylori infection among Egyptian children: impact of social background and effect on growth

OBJECTIVE: The study aim was to assess the prevalence of Helicobacter pylori infection in Egyptian schoolchildren and its effect on growth parameters. DESIGN: A cross-sectional population-based study was conducted among 286 schoolchildren (168 boys and 118 girls), with a mean age of 11.04 +/- 0.19 years, to determine the prevalence of H. pylori. The presence of the bacterium was assessed using the [13C]urea breath test. Relevant personal and socio-economic data on risk factors for infection were collected. Height and weight were analysed in relation to H. pylori infection. RESULTS: The overall prevalence of H. pylori infection was 72.38%. Attending school in a socially deprived area and residing in an overcrowded home were the major risk factors for infection. Differences between infected and non-infected children were significant with regard to body weight and height (weight: 39.5 +/- 1.0 vs. 44.6 +/- 1.8 kg, P = 0.05; height: 139.9 +/- 1.3 vs. 144.2 +/- 2.1 cm; P = 0.009). The number of children (both boys and girls) falling below the 5th percentile of height-for-age was significantly higher in infected than non-infected children (P = 001), similarly for Z-scores for height-for-age below -2.0 (P = 0.003). CONCLUSION: The results demonstrate not only that the prevalence of H. pylori infection is extremely high among Egyptian schoolchildren, but also that the adverse effects of the infection reach far beyond the stomach. Evidence of the burden of infection on growth failure is presented.     

Exploring the relationship between sugars and obesity

OBJECTIVE: Investigate the relationship between body mass index (BMI) and intake of sugars and fat in New Zealand adults and children. DESIGN: Secondary analyses of National Nutrition Survey (1997) and Children's Nutrition Survey (2002) data for the New Zealand population. BMI calculated from height and weight; fat, sugars and sucrose (used as a surrogate for added sugars) intakes estimated from 24-hour diet recall. Ethnic-specific analyses of children's data. Relationships (using linear regression) between BMI and sugars/sucrose intakes; per cent total energy from fat; mean total energy intake from sucrose. Subjects classified into diet-type groups by levels of intake of fat and sucrose; relative proportions of overweight/obese children in each group compared with that of normal weight subjects using design-adjusted chi2 tests. SETTING: New Zealand homes and schools. SUBJECTS: 4379 adults (15+ years); 3049 children (5-14 years). RESULTS: Sugars (but not sucrose) intake was significantly lower among obese compared to normal weight children. In adults and children, those with the lowest intake of sugars from foods were significantly more likely to be overweight/obese. Sucrose came predominantly from beverages; in children, 45% of this was from powdered drinks. Sucrose intake from sugary beverages was not related to BMI. Per cent total energy (%E) from sucrose was significantly inversely related to %E from fat among adults and children. Proportions of overweight/obese adults or children in each diet-type group did not differ from that of normal weight individuals. CONCLUSIONS: Current sugars or sucrose intake is not associated with body weight status in the New Zealand population.     

Validation of a food-frequency questionnaire for measurement of nutrient intake in a dietary intervention study

OBJECTIVE: To validate a 171-item semi-quantitative food-frequency questionnaire (FFQ) for measurement of nutrient intake in an intervention trial based on walnut supplementation. DESIGN AND SETTING: Free-living adults from Southern California were randomly assigned to either an intervention (walnut-supplemented) or a control diet. The prescribed 6-month intervention was > or = 28 g of walnuts per day for the walnut-supplemented group and > or = 2 g of walnuts per day for the control group. Participants provided at least six 24-hour dietary recalls and completed a self-administered FFQ. SUBJECTS: Eighty-seven adults aged 30-72 years (48 females, 39 males). RESULTS: Our findings from validation (by correlation with six diet recall measures) of the measurement of 32 nutrients by the FFQ are as follows. We found significant positive correlations (corrected for measurement error) between the FFQ and diet recalls for total energy (r = 0.34), total carbohydrate (r = 0.42), vegetable protein (r = 0.43), total fat (r = 0.51), polyunsaturated fat (r = 0.77), total fibre (r = 0.60), linoleic acid (r = 0.78) and alpha-linolenic acid (r = 0.79) - the last nutrient being an excellent nutrient biomarker of the intervention (walnut supplementation). Significant positive correlations were also found for vitamin C (r = 0.96) and certain minerals (r = 0.46-0.80 for calcium, phosphorus, magnesium, iron and potassium). Uncorrected correlations were also high (r>0.40) for retinol, beta-carotene, folate and alcohol. Both diet recalls and FFQ showed a similar significant difference in alpha-linolenic acid content between the walnut-supplemented and control diets. CONCLUSIONS: The FFQ demonstrated good relative validity in the estimation intake of some of the major nutrients in a dietary intervention trial and was a particularly valid estimate of an important nutrient biomarker of walnut supplementation.     

Dietary and non-dietary determinants of central adiposity among Tehrani women

OBJECTIVE: To determine the correlates of central adiposity. DESIGN: Population-based cross-sectional study. SUBJECTS: A total of 926 women (aged 40-60 years) from all districts of Tehran. METHODS: Demographic data were collected and anthropometric indices were measured according to standard protocols. Dietary intakes were assessed by means of a semi-quantitative food-frequency questionnaire. The suggested cut-off point for waist-to-hip ratio (WHR>or=0.84) for Tehrani people, adjusted for their age group, was used to determine central adiposity. Logistic regression analysis was used to determine the correlates of WHR, which were adjusted for age, taking medications and body mass index (BMI). The components of dietary intake were determined by factor analysis. Pearson correlation was used to determine the association between the dietary components and WHR. Analysis of covariance was employed to compare the mean values of WHR in different lifestyle groups, with adjustment for BMI and age. RESULTS: Mean WHR was 0.82 +/- 0.06. The possibility of being centrally obese was higher in women with light physical activity (odds ratio: 2.11; 95% confidence interval: 1.40-2.53), depressed women (1.36; 1.02-1.93), smokers (1.21; 1.02-1.56) and unemployed women (1.41; 1.13-1.72). Marriage (1.31; 1.10-1.82), menopause (1.22; 1.02-1.61), low vitamin C intake (2.31; 1.25-4.25) and low calcium intake (1.30; 1.07-3.78) were associated with central fat accumulation. Dairy consumption was inversely correlated with central fat accumulation (r = -0.2, P < 0.05). CONCLUSION: Central adiposity is associated with poor lifestyle factors including low physical activity, depression, smoking, low intake of vitamin C, low intake of calcium and dairy products and high fat consumption. Thus lifestyle modifications should be encouraged to achieve a healthier body shape.     

Calcium, diet and fracture risk: a prospective study of 1898 incident fractures among 34 696 British women and men

OBJECTIVE: The risk factors for fractures are incompletely understood. An outstanding question concerns the optimal amount of dietary calcium needed to minimise the risk of fracture. DESIGN: We examined the associations of dietary calcium and other nutrients with self-reported fracture risk in a prospective cohort study. Nutrient intakes were estimated using a semi-quantitative food-frequency questionnaire administered at recruitment. SETTING: The UK. Participants: A total of 26 749 women and 7947 men aged 20-89 years. RESULTS: Over an average of 5.2 years of follow-up, 1555 women and 343 men reported one or more fractures, 72% of these resulting from a fall. Among women, fracture risk was higher at lower calcium intakes, with a relative risk of 1.75 (95% confidence interval (CI) 1.33-2.29) among women with a calcium intake of < 525 mg day- 1 compared with women with a calcium intake of at least 1200 mg day- 1 (test for linear trend, P < 0.001). The association of dietary calcium with fracture risk was stronger among women aged under 50 years at recruitment than among women aged 50 and above. Dietary calcium intake was not associated with fracture risk in men. Fracture risk was not related to the dietary intake of any other nutrient examined. CONCLUSION: In this population, women with a low dietary calcium intake had an increased risk of bone fracture, and this association was more marked among younger women than among older women.     

Efficacy and safety of food fortification with calcium among adults in Finland

OBJECTIVE: To examine the efficacy and safety of foods fortified with calcium in the adult population in Finland. DESIGN: A simulation study based on the FINDIET 2002 Survey, which estimated habitual food consumption, dietary supplement use and nutrient intakes using 48-hour recall and two 3-day food records, and an Internet survey of the consumption of fortified foods and dietary supplements. SETTING/PARTICIPANTS: Participants of FINDIET 2002 were 25-64 years old from five areas (n = 2007). Participants of the Internet-based survey (n = 1537) were over 15 years of age from all over the country. RESULTS: If all potentially fortifiable foods were to be fortified with calcium, the proportion of participants with calcium intake below the recommended level (< 800 mg day(-1)) would decrease from 20.3% to 3.0% in men and from 27.8% to 5.6% in women compared with the situation where no foods were fortified. At the same time, the proportion of participants with calcium intake above the tolerable upper intake level (UL, > 2500 mg day(-1)) would increase from 0.6% to 12.7% in men and from 0.1% to 3.8% in women. However, in a probability-based model (11% of all fortifiable foods to be fortified with calcium) the proportion of participants with calcium intake below the recommended level would be 15.7% in men and 23.2% in women. The proportion with intake above the UL in this model would be 1.2% in men and 0.7% in women. CONCLUSIONS: Food fortification would be a relatively effective and safe way to increase the calcium intake of the Finnish adult population.     

The impact of a school-based nutrition education intervention on dietary intake and cognitive and attitudinal variables relating to fruits and vegetables

OBJECTIVE: To assess the impact of a school-based nutrition education intervention aimed at increasing the consumption of fruits and vegetables. DESIGN: The intervention programme increased the provision of fruits and vegetables in schools and provided a range of point-of-purchase marketing materials, newsletters for children and parents, and teacher information. Curriculum materials at age 6-7 and 10-11 years were also developed and utilised. Evaluation was undertaken with groups of younger (aged 6-7 years) and older (aged 10-11 years) children. Methods included 3-day dietary records with interview and cognitive and attitudinal measures at baseline, with follow-up at 9 months, in intervention and control schools. SETTING: The work was undertaken in primary schools in Dundee, Scotland. SUBJECTS: Subjects comprised 511 children in two intervention schools with a further 464 children from two schools acting as controls. RESULTS: Children (n=64) in the intervention schools had an average increase in fruit intake (133+/-1.9 to 183+/-17.0 g day(-1)) that was significantly (P<0.05) greater than the increase (100+/-11.7 to 107+/-14.2 g day(-1)) estimated in children (n=65) in control schools. No other changes in food or nutrient intake were detected. Increases in scores for variables relating to knowledge about fruits and vegetables and subjective norms were also greater in the intervention than in the control group, although taste preferences for fruits and vegetables were unchanged. CONCLUSIONS: It is concluded that a whole school approach to increasing intakes of fruits and vegetables has a modest but significant effect on cognitive and attitudinal variables and on fruit intake.     

Development and validation of a short questionnaire to assess sodium intake

OBJECTIVES: To develop and validate a short food-frequency questionnaire to assess habitual dietary salt intake in South Africans and to allow classification of individuals according to intakes above or below the maximum recommended intake of 6 g salt day-1. DESIGN: Cross-sectional validation study in 324 conveniently sampled men and women. METHODS: Repeated 24-hour urinary Na values and 24-hour dietary recalls were obtained on three occasions. Food items consumed by >5% of the sample and which contributed > or =50 mg Na serving-1 were included in the questionnaire in 42 categories. A scoring system was devised, based on Na content of one index food per category and frequency of consumption. RESULTS: Positive correlations were found between Na content of 35 of the 42 food categories in the questionnaire and total Na intake, calculated from 24-hour recall data. Total Na content of the questionnaire was associated with Na estimations from 24-hour recall data (r = 0.750; P < 0.0001; n = 328) and urinary Na (r = 0.152; P = 0.0105; n = 284). Urinary Na was higher for subjects in tertile 3 than tertile 1 of questionnaire Na content (P < 0.05). Questionnaire Na content of <2400 and > or =2400 mg day-1 equated to a reference cut-off score of 48 and corresponded to mean (standard deviation) urinary Na values of 145 (68) and 176 (99) mmol day-1, respectively (P < 0.05). Sensitivity and specificity against urinary Na > or =100 and <100 mmol day-1 was 12.4% and 93.9%, respectively. CONCLUSION: A 42-item food-frequency questionnaire has been shown to have content-, construct- and criterion-related validity, as well as internal consistency, with regard to categorising individuals according to their habitual salt intake; however, the devised scoring system needs to show improved sensitivity.